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Real and Updated Medical Council of Canada MCCQE Exam Questions
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Medical Council of Canada MCCQE Part 1 Exam Sample Questions (Q177-Q182):
NEW QUESTION # 177
A 78-year-old woman is brought to the Emergency Department by her son because she has a sodium level of
124 mmol/L (136-146). The sodium was checked as part of a blood work panel ordered by her primary health care provider to investigate symptoms of urinary frequency, fatigue, and thirst. Today, she has a blood glucose level of 44.0 mmol/L (4.0-11.0). The original blood work done by her primary health care provider did not include glucose. The patient is treated for hyperglycemia and dehydration and begins insulin. The patient and her son repeatedly express their frustration that their primary health care provider missed the diagnosis. Which one of the following is the best next step?
- A. Report the primary health care provider to the provincial or territorial medical regulatory authority
- B. Explain that routine glucose screening was not indicated
- C. Empathize with the patient and her son and agree that the health care provider did not meet the standard of care
- D. Call the primary health care provider to alert them to their oversight
- E. Offer to find an alternate health care provider to assume the patient's primary care
Answer: D
Explanation:
In situations involving potential oversight, the appropriate next step is to contact the other physician directly.
This supports collegial communication, continuity of care, and provides an opportunity to clarify the clinical situation. It avoids premature judgment while allowing the primary provider to respond and address concerns.
Toronto Notes 2023 - ELOM, "Professionalism and Interprofessional Communication":
"When concerns arise about another provider's care, direct communication is preferred before considering formal reporting. This maintains collaboration and fairness." MCCQE1 Objectives (ELOM > 90-2: Communication and Accountability):
"Candidates must demonstrate collegiality and appropriate methods for addressing concerns regarding another physician's care." Empathizing (D) and validating blame is unprofessional. Reporting (B) is premature. Offering another provider (C) could undermine continuity. (E) is incorrect since the glucose should have been checked based on the presenting symptoms.
NEW QUESTION # 178
You are examining a full-term baby girl in the nursery. You notice that her left forefoot is adducted and supinated relative to the contralateral foot, which makes her left foot appear C-shaped. Which one of the following findings is most instrumental in deciding on the management of this issue?
- A. Cephalohematoma
- B. Flexibility of the deformity
- C. Internal tibial torsion
- D. Significant hallux valgus
- E. Syndactyly of 2nd and 3rd toes
Answer: B
Explanation:
The description is classic for metatarsus adductus. The most important clinical factor guiding management is whether the foot is flexible or rigid. Flexible deformities typically resolve spontaneously and do not require intervention.
Toronto Notes 2023 - Pediatrics, "Musculoskeletal Conditions":
"Metatarsus adductus: inward deviation of the forefoot. Management depends on flexibility. Flexible cases are benign and resolve spontaneously; rigid forms may need casting." MCCQE1 Objectives (Pediatrics > 78-2: Musculoskeletal Disorders):
"Candidates must assess and differentiate between flexible and rigid deformities to guide treatment in foot abnormalities." Other findings (B-E) are either unrelated or not determinant in metatarsus adductus management.
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NEW QUESTION # 179
A 15-year-old boy is brought to your office because of concerns about his breast development. He has no other symptoms. His physical examination does not reveal any other abnormality. Which one of the following is the best next step?
- A. Reassure the patient
- B. Order cranial magnetic resonance imaging
- C. Perform serum prolactin level
- D. Order adrenal ultrasound
- E. Perform serum estrogen level
Answer: A
Explanation:
Comprehensive and Detailed Explanation:
The image and clinical history are consistent with physiologic pubertal gynecomastia, which is common in adolescent boys. It usually resolves spontaneously within 6 months to 2 years and does not require investigation unless other signs of endocrine pathology are present.
Toronto Notes 2023 - Pediatrics / Endocrinology:
"Pubertal gynecomastia is benign, self-limited, and common in adolescent males. No further investigation is needed in the absence of systemic signs." MCCQE1 Objectives (Pediatrics > 77-2: Endocrine Disorders):
"Candidates must differentiate physiologic gynecomastia from pathologic causes based on history and physical exam." Other tests (A-C, E) are unnecessary unless there are red flags (e.g., testicular mass, rapid progression, neurological symptoms).
-
NEW QUESTION # 180
A 37-year-old woman presents to your clinic with frequent palpitations. She has no other symptoms and is quite active. Physical examination and resting electrocardiogram findings are normal. Which one of the following is the best next step?
- A. Echocardiogram
- B. Treadmill exercise test
- C. Holter monitoring
- D. #-Blocker
Answer: C
Explanation:
Comprehensive and Detailed Explanation:
The most appropriate next step for a patient with intermittent palpitations and a normal ECG is Holter monitoring (or event monitoring). This can capture and correlate symptoms with cardiac rhythm.
Toronto Notes 2023 - Cardiology, "Palpitations":
"Holter or event monitoring is indicated when the initial ECG is normal but the patient has episodic symptoms such as palpitations." MCCQE1 Objectives (Cardiology > 34-2: Arrhythmia):
"Candidates must use ambulatory ECG monitoring to investigate intermittent palpitations when resting ECG is unremarkable." Echocardiogram (A) assesses structural issues but not rhythm. #-blockers (B) should not be started without diagnosis. Stress testing (D) is for ischemia.
NEW QUESTION # 181
A mother brings her previously healthy 4-month-old girl for evaluation due to fussiness for 3 weeks. The infant becomes irritable and cries with occasional body arching 1-2 hours after feeding, frequently spits up after feeds, has developed feeding aversion, and shows slowing weight gain. She has been on cow's milk- based formula since birth. Stools are normal, and physical examination is unremarkable. Which one of the following is the most likely diagnosis?
- A. Intermittent intussusception.
- B. Celiac disease.
- C. Hypertrophic pyloric stenosis.
- D. Peptic ulcer.
- E. Gastroesophageal reflux disease.
Answer: E
NEW QUESTION # 182
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